Extensive Myocardial Calcification Following Fulminant Neonatal Enteroviral Myocarditis

Abstract

Myocardial calcification is a rare but important complication of fulminant neonatal myocarditis, a potentially life-threatening condition. Only a handful of neonatal cases have been reported in the literature. We present the case of a previously healthy seven-day-old term male neonate who developed cardiogenic shock secondary to enteroviral myocarditis with confirmed central nervous system involvement. Despite prompt initiation of inotropic therapy, he required venoarterial extracorporeal membrane oxygenation (VA-ECMO) within 48 hours of admission. While on mechanical circulatory support, serial imaging showed progressively increased myocardial echogenicity on echocardiography and later curvilinear myocardial calcification on chest radiograph. The clinical course was characterised by persistent cardiac dysfunction and progression to irreversible multiorgan failure. Heart transplantation was deemed unfeasible, and life-sustaining therapies were withdrawn, following multidisciplinary discussion and family consultation. An autopsy was not performed. This case highlights myocardial calcification as a potential imaging marker of irreversible myocardial injury in fulminant neonatal myocarditis. Early recognition of progressive myocardial echogenicity and subsequent calcification may provide valuable prognostic information, helping clinicians assess disease severity and support informed decision-making in cases of fulminant neonatal myocarditis.